Home ►
POE-AG minutes ►
Florida and U.S. Virgin Islands Part B POE-AG minutes – March 20, 2025
Last Modified: 3/25/2025
Location: FL, USVI
Business: Part B
Jurisdiction N
Medicare Part B
March 20, 2025
Janice Mumma, Supervisor, welcomed the members and reviewed current committee guidelines.
Janice advised the purpose of the POE AG is to assist the contactor in the creation, implementation, and review of provider education events. We conduct this meeting to allow provider feedback on training topics, provider education materials, dates, and times of provider education events.
Contractor Medical Director, Dr. David Sommers, joined us today. He provided the group with an overview on Local Coverage Determinations (LCD) which included the role of the Medicare Administrative Contractor (MAC), process of LCD development, and the Journey to LCD Coverage tool. A question was received asking what “grade methodology” is. Dr. Sommers provided a brief summary/description.
The group discussed the attendance at the prior webinars. The highest and lowest attended prior quarter activities were reviewed, and feedback was requested. Feedback was received regarding the low attendance events. Janice advised that she feels it is due to the end of 2024/beginning of 2025. She also advised that we have a few new marketing ideas for 2025.
The upcoming activities for the remainder of March 2025 were reviewed. April calendar has been posted. The May calendar is in development and will be posted. No feedback was received.
Janice reviewed the CMS website
Education and Training page 
. This page offers information on CMS national training program, partner outreach resources, Medicare Learning Network, CMS open door forums, look up topics, and find provider type.
First Coast has complied two new resources to help providers navigate the CERT program:
CERT Insider’s Guide and
CERT Fast Facts. The Insider’s Guide will be issued quarterly, and the Fast Facts will be issued monthly. Both publications can be accessed from the
CERT page on our website.
The 2025 education strategy was reviewed. The strategy includes topics presented in a workshop series, monthly, bi-monthly, and quarterly events on a variety of topics, and the annual virtual symposium. We are continuing the StayConnected workshop series in 2025, as well as introducing a new workshop series, Medicare Navigator. The Medicare Navigator series is a series of events that are focused on assisting providers to navigate to, identify, perform, submit, etc. necessary Medicare tasks. Topics are chosen from various sources: provider suggestions and surveys, CERT data, MR, data, and claim submission errors to name a few. Watch our
events calendar for monthly updates.
A question was asked regarding an events calendar that showed webinars on global surgery specifically and where it was located. Janice took the group out to the First Coast website and gave instructions on how to find/register for our webinars.
First Coast has a wide array of
on-demand learning resources. These resources are intended for you to participate in Medicare education at your own pace, on your schedule.
First Coast is active in social media. LinkedIn and YouTube are live. Subscribe today and please promote these social media tools to your colleagues.
The 2025 Deductible, Coinsurance, and Premium Rates have been released. The 2025 Part A deductible is $1676, and the 2025 Part B Deductible is $257 with Coinsurance being 20%. For complete details, please review
Change Request (CR) 13796 
.
The PT and SLP combined threshold is now $2,410 and OT is $2,410. The medical record threshold amount they are as follows: PT and SLP services combined remains at $3,000 and OT services remains at $3,000.
Note: These threshold amounts will remain in place until CY2028 at which time will be updated by the Medicare Economic Index (MEI) review. For more information, review
Change Request (CR) 13826 .
Updates have been made to the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the CY 2025 HCPCS/CPT. This list allows physicians and certain non-physician practitioners (NPPs), including nurse practitioners, physician assistants, and clinical nurse specialists, to provide these services outside a therapy plan of care when appropriate and when furnished under a plan of care. A modifier must be used (GP, GO or GN) to reflect that it’s under a physical therapy, occupational therapy, or speech-language pathology plan of care. For complete details, please review
Change Request (CR) 13823 .
CMS issued a rule finalizing changes for Medicare payments under the PFS and other Medicare Part B policies, effective on or after January 1, 2025.
A summary of those Medicare policies include:
• Telehealth
• Caregiver training
• Therapy
• Cardiovascular risk assessment and management
• Evaluation and management
• Behavioral health
• Advanced primary care management
• Global surgery payment
• Dental and oral health
Effective with dates of service on and after January 1, 2025, CMS made updates to the list of codes and modifier usage for G2211. G2211 is payable with E/M codes and modifier 25, when the service or other procedure meets the requirement of modifier 25. Method II Critical Access Hospitals must use type of bill 85X (revenue codes 096x, 097x, or 098x). For more information, please review
Change Request 13705 .
Effective with dates of service on and after January 1, 2025, CMS developed new codes for Advanced primary care management services. These codes are G0556, G0557 and G0558.
These codes provide patients with a wide range of services to meet their individual needs based on complexity, allow providers to bill for these services using a monthly bundle (instead of billing for each individual service or recording minute by minute), and help simplify billing and documentation requirements while ensuring that your patients have access to high-quality primary care services. For complete details on these new codes visit the CMS
website .
CMS has added additional actions to help support access to behavioral health. New coding has been developed to support access to behavioral health. Coding and payment describing safety planning interventions for patients in crisis can be billed using HCPCS code G0560. This code can be performed via telehealth.
To further support psychotherapy services, CMS finalized payment for Medicare for approved digital mental health treatment devices (DMHT) provided incident to professional behavioral health services used with ongoing behavioral health treatment under a plan of care. The DMHT device must have been previously approved by the FDA. The new HCPCS codes include: G0552, G0553, and G0554.
CMS is adding 6 new HCPCS codes (G0546-G0551) for interprofessional consultation by practitioners. These services can be performed by a billing practitioner who is authorized to furnish services for the diagnosis and treatment of mental illness, which includes:
• Clinical Social Workers
• Mental Health Counselors
• Marriage and Family Therapists
• Clinical Psychologists
• Physicians and NPPs
Effective for dates of services on and after January 1, 2025, providers begin to bill using HCPCS code G0559. This code must be reported separately in addition to an office or outpatient E/M service. G0559 may only be reported once during the 90-day global period. For complete details on this new code, please review the
global surgery booklet .
Modifier 54 is required for all 90-day global surgical services when a practitioner plans to furnish only the surgical procedure portion of the global package (including both formal and other transfers of care).
Modifiers 55 and 56 will continue to be billed exclusively in cases where there is a documented formal transfer of care. The formal documented transfer of care agreement should be the form of a letter or an annotation in the discharge summary, hospital record, or Ambulatory Surgical Center (ASC) record.
Telehealth guidelines that were in effect for 2024 have been extended until March 31, 2025. Telehealth guidelines for the 2025 CY will be provided once they are finalized by CMS.
The 2025 MEDPARD is now available. Please visit our
website for the entire listing.
Beginning September 30, 2024, Medicare covers PrEP for preventing HIV in individuals at an increased risk of getting HIV, without cost sharing. This drug can be billed by a pharmacy, physicians, health care practitioners, and institutional settings.
Medicare will cover the following as an additional preventive service:
Up to 8 individual counseling visits every 12 month
Up to 8 HIV screening tests every 12 months
Single screening for hepatitis B virus
Effective January 1, 2025, CMS added a new HCPCS code, Q0521, for pharmacies billing for PrEP for HIV drugs. If a physician or health care practitioner prescribes PrEP, at least one valid ICD-10 diagnosis code should be included to help pharmacies submit their claims. CMS has a number of
resources and references on their website that can assist you.
A question was asked regarding modifier 24 and if it is still valid. Robert advised that as far as he knows, modifier 24 is still able to be used when billing claims to Medicare.
Our next POE AG meetings will be July 24, 2025, and November 13, 2025.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
